​How Mental Health Experts Are Secretly Rewriting Television

Think of it as mental health product placement.​

A couple of years ago, when Judi Clements tuned into "Shortland Street," a popular soap opera in New Zealand, she said she was shocked to see a depiction of one of the characters, Bree, who suffered from a mental illness, and upon being released from an institution, killed her sister. Another character on the show was diagnosed with bipolar disorder and simply "disappeared" into care.

In a letter addressed to the producers of the show, Clements, chief executive of the Mental Health Foundation of New Zealand, wrote to point out that those experiencing mental illness are more likely to be victims of crime rather than perpetrators. She criticized the vanishing of a character with bipolar disorder as misleading, as millions of people live in society with it and aren't sent off to "antiquated" depictions of funny farms or aren't, as Clements said, "axe-wielding maniacs."

"There are all sorts of misunderstandings [about mental health] that help movies make money," Clements said. "But don't help people understand mental distress."

The MHF claims to be among the first charitable trusts in the world to receive government funding that is focused on combatting stigma surrounding mental health and going about it in a perhaps unorthodox way: shadow consulting to television and film writers. Today, others around the world are now looking at the work the Kiwis are doing surrounding the issue, as part of Time to Change, a new global alliance started in October 2007 that shares the same mission of breaking down the taboos surrounding mental health.

Historically, mental illness has had a checkered history in its pop culture depictions. While characters like Norman Bates in Psycho or Annie Wilkes in Misery have entertained, they haven't exactly served as templates for everyday people who carry on lives with mental health diagnoses or may already be wary about discussing their mental health with others.

This older "Shortland Street" clip ends with a classic, and misguided, "I'm not crazy!" trope that provides a misleading caricature of mental health issues.

Yet such on-screen depictions can be powerful. Some 54 percent of British viewers surveyed who saw a mental health problem on TV said that it helped them improve their understanding of mental health and surrounding issues, and 31 percent said that it kicked off discussions about the storyline with family, friends or coworkers, according to a 2010 report from Time to Change and the Glasgow Media Group. Further, mental health discussions have helped in the increasing trend of "dual screen" viewing, as 15 percent of those surveyed said they had discussed a mental health issue storyline on social media.

However, while powerful, depictions on film or on TV are not always accurate. Mental health consultants said that this includes having characters being restrained in straitjackets, even as their contemporary use is completely out of vogue; the use of derogatory language to imply that someone in mental distress should be feared; showing medication as an instant, miracle cure; or graphic depictions of suicide methods which can encourage copycat behavior.

Many organizations have long relied on public service campaigns to improve understand of mental illness, and have worked with journalists to correct the language they use when reporting on celebrity suicides. While that work will continue in New Zealand, mental health advocates said that the tactic of working with TV and film writers is cheaper than buying advertising time, and perhaps more effective, as it reaches audiences who may tune out public service announcements or may not be prone to seeking out resources themselves. Think of it as mental health product placement.

"Generally, we feel this kind of work is much smaller, but these things are seen by so many people, it can have a big impact," Jenni Regan, senior media advisor with the United Kingdom-based Time to Change, one of the nation's largest mental health charities. For more than four years, Regan said she has worked on several dozen television and film scripts, including several high-profile UK soap operas. Currently, Regan is expanding into theater, as she is consulting on a production of "Hamlet" with the Royal Shakespeare Company.

Think of it as mental health product placement.

"What's interesting is now people are moving beyond more common things like depression and anxiety to less common conditions," Regan said. Recently, she was involved with a large storyline on the British show "EastEnders" that involved a character who developed postpartum psychosis. Regan connected writers and producers with the show with women who themselves had suffered from the relatively rare condition. "The two women we had meet with the people on the show could paint a picture, create an in-depth storyline," she said.

Meanwhile, on the "Shortland Street" set in New Zealand, upon receiving the letter from Clements, a crew of four mental health experts with the MHF worked with the screenwriters, producers and actors of the show to develop storylines revolving around one character's diagnosis with bipolar disorder and another character's suicide attempt. In constructing story arcs, they weighed scientific accuracy with the need for drama on screen, striking a balance between both. Then, they collaborated to make resources tied to the show available on their website for viewers who wanted to learn more.

"Youth suicide is a huge problem in New Zealand and has been ever since I was growing up," Joss King, the head writer of "Shortland Street," said. "The show had done it a number of times, but it was a personal issue and I wanted to do it again. It's a vexed subject and we wanted to do it in a responsible way."

Some of what was done in script advisement included removing specifics on suicide methods. The writers also showed how friends and family can provide support after a suicide attempt, and how someone can survive and work through depression rather than just disappear from the narrative. "Shortland Street" even hired a nurse to consult on the show, as well.

"The challenge was to try and tell a story that held its own dramatically, while still remaining true to a story that could help people," King said. "We wanted to go deep into the character and in the end, we got a story of a young man's journey from a tough place in his life, a place of vulnerability, to realizing that there was still life out there to be lived. You look for the jeopardy, dramatic plot points, but we wanted to go beyond those points of jeopardy here and not be too salacious, ending on a more emotional side. We erred more on telling an empathetic story, but we also didn't want to glamorize depression."

When the episode concerning youths suicide aired in October 2014, MHF staff worked with the "Shortland Street" social media staff to monitor reactions to the show and direct tweeters to hotlines. Thousands of likes and shares and retweets later, those involved hope to replicate the success on other shows. King, citing his experience with that storyline, said he hopes to pursue additional mental health topics in future episodes.

"We wanted to get to the heart of the issue," King said. "Tough and depressing stories are easy to tell, but stories that encapsulate hope are more challenging—and more rewarding."